This document outlines standard operating procedures for treating glaucoma patients. It describes how to select patients for glaucoma treatment based on factors like high eye pressure, risk factors, and suspected disc changes on examination. It then details the workup, which includes tests of eye pressure, examining the eye's drainage angles, and assessing the optic nerve. For patients with closed drainage angles, treatments like laser and eye drops are recommended. The document provides guidelines for follow up visits and tests, baseline investigations, setting target eye pressure levels, medical management, and surgical indications if targets cannot be reached with medication.

1. SOP FOR GLAUCOMA
Dr Mayuri Borgohain
MBBS, MS Ophthalmology
Fellowship Glaucoma

2. SELECTION OF PATIENTS
1. HIGH IOP
2. CASES WITH RISK FACTORS (AGE >40, F/H/O GLAUCOMA, H/O STEROID USE, POST
RDSX, PKSX, MYOPIA, HYPERMETROPIA, ETHNICITY, DM, HTN)
3. SUSPECTED DISC ON FUNDOSCOPY
4. ACUTE CASES

3. GLAUCOMA WORK-UP
1. GAT (NORMAL/LOW/HIGH)
2. GONIOSCOPY (DIRECT AND COMPRESSION)
3. DILATE IF ANGLES ARE OPEN
4. FUNDOSCOPY

4. IF ANGLE CLOSED
1. INVESTIGATIONS: ASOCT - ANGLE
2. LASER PI+STEROID E/D+BRIMONIDIN E/D+/- OTHER AGM EXCEPT PGA
3. FOLLOW UP AFTER 1 WEEK

5. 1 WEEK FOLLOW UP:
1. REPEAT ASOCT-ANGLE
2. REPEAT GONIO PHOTO
3. REPEAT REFRACTION, GAT
4. DILATE FOR FUNDOSCOPY

6. BASELINE INVESTIGATIONS:
1. PACHYMETRY
2. PERIMETRY 30-2, 10-2
3. OCT RNFL
4. FUNDUS PHOTO 30º
5. GONIO PHOTO
ADDITIONAL INVESTIGATIONS: GCC ( Preperimetric glaucoma, myopia where
diagnosis is difficult)

7. DVIOP (10AM, 12 AM, 2AM, 4AM, 6AM) BY SINGLE EXAMINER
FINAL DIAGNOSIS
SET TARGET IOP (MILD 15-17, MOD 12-15, SEVERE 10-12, SUSPECT 20%)

8. MEDICAL MANAGEMENT
1. PGA, BB, CAI, AA, OA, MIOTICS
2. REVERSE UNIOCULAR TRIAL( CHANGE/ADDITION)
3. COMBINATION DRUGS
4. NEWER DRUGS

9. 1. 1ST FOLLOW UP 4-6 WEEKS.
2. TARGET IOP ACHIEVED, FOLLOW UP EVERY 3 MONTHS
3. TARGET IOP NOT ACHIEVED, FOLLOW UP EVERY 4-6 WEEKS.

10. FOLLOW UP INVESTIGATIONS
1. PERIMETRY 30-2, 10-2
2. OCT RNFL

11. SURGICAL INDICATION
1. TARGET IOP NOT ACHIEVED WITH MAXIMUM MEDICATIONS
2. INTOLERANCE TO MEDICATIONS/POOR COMPLIANCE
3. CONGENITAL/JUVENILE/SECONDARY GLAUCOMAS

12. THANK YOU
REFERENCES
SHIELDS TEXTBOOK OF GLAUCOMA
SIHOTA R ET AL. SIMPLIFYING TARGET INTRAOCULAR PRESSURE FOR DIFFERENT STAGES OF POAG AND PACG. INDIAN J
OPHTHALMOL2018;66:495-505